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Organization
FAMILY THERAPY INSTITUTE MIDWEST
Active
Organization
FAMILY THERAPY INSTITUTE MIDWEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LU EGIDY APRN (OWNER)
(785) 830-8299
Entity
Organization
Contact information
Practice address
2619 W. 6TH STREET, SUITE C, LAWRENCE, KS 66049
(785) 830-8299
(785) 749-2581
Mailing address
2619 W. 6TH STREET, SUITE C, LAWRENCE, KS 66049
(785) 830-8299
(785) 749-2581
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
0894
KS
103TC2200X
Clinical Child & Adolescent Psychologist
1109
KS
104100000X
Social Worker
6890
KS
1041C0700X
Clinical Social Worker
1740
KS
1041C0700X
Clinical Social Worker
3569
KS
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
46111
KS
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
74564
KS
Other
Enumeration date
06/24/2006
Last updated
11/07/2016
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